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Chapter 50. Rheumatoid Arthritis

Which of the following may be useful in the symptomatic management of rheumatoid arthritis but does not reduce overall disease progression?

a. Methotrexate

b. Indomethacin

c. Infliximab

d. Abatacept

Answer b is correct. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that may be used for control of pain and inflammation while awaiting the onset of disease-modifying antirheumatic drug (DMARD) action or during disease flares; however, it does not slow the progression of joint erosion or overall disease progression.

Answers a, c, and d are incorrect. Methotrexate, infliximab, and abatacept are all DMARDs which by definition are disease-modifying and prevent progressive joint damage and erosion. Methotrexate is a conventional synthetic DMARD (csDMARD) while infliximab and abatacept are targeted biologic DMARDs (boDMARDs) (infliximab being a tumor necrosis factor (TNF) inhibitor and abatacept being a non-TNF inhibitor).

Which of the following choices describe the appropriate use of glucocorticoids in the management of rheumatoid arthritis? Select all that apply.

a. Bridge therapy

b. Long-term, low dose

c. Short-term, high dose

d. Long-term, high dose

Answers a, b, and c are correct. Glucocorticoids may be used as bridge therapy while awaiting the onset of action of disease-modifying antirheumatic drugs (DMARDs) given their rapid onset and ability to reduce pain and inflammation. Long-term, low dose glucocorticoids are recommended if patients fail to achieve disease control on DMARDs. Short-term, high dose glucocorticoids may be required to regain control of symptoms during disease flares.

Answer d is incorrect. The long-term use of high dose glucocorticoids is not recommended due to undesirable adverse effects such as osteoporosis. Though glucocorticoids do have disease-modifying properties and can slow joint damage and erosion, they are not used as monotherapy due to their adverse event profile.

Which of the following agents is dosed weekly?

a. Methotrexate

b. Leflunomide

c. Hydroxychloroquine

d. Sulfasalazine

Answer a is correct. Methotrexate is dosed weekly and is available orally and for intramuscular, subcutaneous, and intravenous injection. Weekly dosing of the drug appears to cause less gastrointestinal toxicity (less damage to the mucosa) and fewer side effects than daily dosing. It is important to be vigilant when reviewing methotrexate prescriptions to verify proper dosing frequency. Emphasize to your patients that this ...

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